Overview of Cerebrovascular Disease: Role of the Endothelium
The circulation of the brain differs from that of other organs in several respects, most notably by the rigorous application of the universal principle that the volume of blood entering an organ cannot exceed that which exits. Unlike other solid organs, the brain is confined within a non-resilient, rigid, bony box — the skull. Parenchymatous organs such as the spleen, kidney, liver and the abdominal viscera, even the skeletal musculature, have the capacity to accommodate transient changes in blood volume and blood pressure. Not so for the brain. An increase in brain volume causes brain substance to press against the unyielding skull and, in severe instances, to seek egress through various channels called foramina — portals via which nerves exit, and blood vessels enter and also exit the cranium. The largest of these channels is the foramen magnum, the pathway for the spinal cord. Literally, the brain is forced out of the skull by the build-up of pressure within it. This is known as herniation of the brain. It is accompanied by loss of consciousness and, if unchecked, may progress to coma and death. Lesser degrees of intracranial pressure while not fatal, result in compromise of neuronal function.
KeywordsGiant Cell Arteritis Moyamoya Disease Cerebral Autoregulation Pulseless Disease Polyarteritis Nodosa
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